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SwinE flu aSSESSmEnT – clinical algoriThm
• This algorithm is intended to be used to assess patients over 1 year old.
It is not for assessment of children under 1 year.
• The assessment includes a series of questions concerning the patient’s
current symptoms and their medical history.
• Unless the patient requires an emergency referral to 999, the algorithm
should be completed to the final question for each patient assessment.
• The assessment involves three steps:
STEP 1 – Determine whether the patient requires ambulance services (999)STEP 2 – Confirm that the patient has flu symptoms and would benefit from antiviral treatmentSTEP 3 – Identify whether the patient requires additional healthcare services
• Step 1 will identify patients who need emergency care. These patients
should be directed to ambulance services (999) immediately.
• Step 2 will determine whether a patient should be authorised to receive
antiviral treatment. If antiviral treatment is required, information about the patient must be used to authorise the correct antiviral for the patient.
• Step 3 will determine whether the patient should seek further assessment or
advice from another healthcare service, and provide appropriate advice for the patient.STEP 1 – Emergency Assessment1.1 Does the patient have any of the following
• Are they unresponsive or unconscious, floppy,
limp, or impossible or difficult to wake?
• Do they have a breathing problem that is
so severe that they are unable to finish a sentence? Or if they are a child under 16, are they breathing irregularly, grunting, or is
their chest collapsing in as they breathe?
• Do they feel that their throat is closing off
and they are unable to swallow saliva or drooling excessively?
• Does their skin feel icy cold and wet to
touch or is there a change in colour – blue or greyness – particularly around the lips, mouth, fingers or toes?
1.2• Does the patient have clusters of tiny purple
spots or a rash that looks like bleeding or
• Or, despite any pain they may have, is the
patient completely unable to move their chin down to touch their chest?
Continue to question 2.1STEP 2 – Flu assessment and authorisation of antiviral treatment2.1 Is the patient less than 1 year old?2.2 Does the patient have a high temperature and at least two of the following symptoms?• Widespread muscle and joint aches• A cough• Headache Continue to question 2.3
• Blocked or runny nose• Sore throat • Vomiting• Watery diarrhoea• Cannot stop crying (only children)
The patient does not have symptoms of flu.
If the patient is seriously unwell they should
Continue to question 3.12.3 Has the patient had flu symptoms Do noT auThoriSE anTiViral TrEaTmEnT2.4 Have these current flu symptoms Do noT auThoriSE
(see question 2.2) been previously treated with
anTiViral TrEaTmEnTContinue to question 3.1auThoriSE anTiViral TrEaTmEnTContinue to question 3.1STEP 3 – Identify whether further assessement or advice is required3.1 Is the patient also experiencing any of these additional symptoms?• Breathing much faster than normal
• Sharp or stabbing chest pain when breathing• Thick yellow, green, brown or bloody phlegm
• Breathing difficulties, for example unable to
complete a sentence or, for children, chest skin sucked between ribs when breathing
• Uncharacteristic changes in behaviour such
as drowsiness, new confusion or appearing terrified (particularly children)
3.2 Has the patient’s condition suddenly
worsened, or if the symptoms have lasted
for more than 7 days (or 5 for a child),
3.3 Is the patient:• Having treatment for immune deficiency• On immunosuppressive drugs such as regular
steroids, methotrexate, azathioprine or cyclophosphamide
• Having, or recently completed, treatment for
• Transplant recipient• HIV positive
Continue to question 3.4Continued from question 3.33.4 Does the patient have any of the following underlying conditions?• Chronic lung disease or asthma which has
been medically treated within the last 3 years
• Diabetes or another metabolic disorder
• Cystic fibrosis• Neurological conditions such as cerebral palsy,
stroke, multiple sclerosis or muscular dystrophy
3.5 Does the patient have any additional symptoms as well as flu? For example:• Drinking much less than usual (less than
half feeds if for a child who is bottle fed)
• Persistent watery diarrhoea• Markedly reduced urine output (or dry
Continue to question 3.6Continued from question 3.5
Advise patient to telephone midwifery team (if have not
3.6 Is the patient pregnant?3.7 Does the patient attend a specialist renal or
kidney clinic for the care of renal or kidney failure?
Provide patient with home care advice and
authorise antiviral treatment if required
End of assessment